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Home My WebLink About0176 BOG ROAD - Health 176 Bog Road Marstons Mills ti -- --- -� . A = 045 017002 --- - i I i I ICI I pp�,��, TOWN OF BARNSTABLE EC LOCATION �� 60 RY SEWAGE #Z(ti3 c376 VILLAGE Aft-3TDU A4LLLS ASSESSOR'S MAP & LOT Z. INSTALLER'S NAME&PHONE NO. _PKIM C SEPTIC TANK CAPACITY LEACHING FACILITY: (type) ( X 1!d (size) NO.OF BEDROOMS BUILDER OR OWNER �L. PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by .� 8- C �Z . A-e aq F l � P 77 SENDER: COMPLETE THIS SECTION COMPLETE.THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also Fore plate; A. Signs re r item 4 if Restricted Delivery is desired. [3Agent ■ Print your name and address on the reverse X ❑Addressee so that we can return the card to you. B. Re ei$ed `P' d Name) Ci a o Delivery ■ Attach this card to the back of the mailpiece, (! G or on the front if space permits. D. Is delivery address different from item 1? ❑Yes j ta 1. Article Addressed to: If YES,enter delivery address below: ❑ No 17(o 25-CA MA 0 2 0 C4 1 3. Service Type 1 Certified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number i ?PO 6 21'5 0 i 0 0�2 i i 10 3-8 �7 4.0 '1._ (Transfer from service/alien PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 I UNITED • Sender: Please print s And +4 ZIP +� th our name P Y addres i •ox • , D �? a I Town of Barnstable N rn Health Division 200 Main St. ' Hyannis, MA 02601 I I'll j F {{ ii `` }}}}tt jj{S j p44 jj }} { � €'llt!lIf)Jslit11s-tStttYl-1Flslii ilili.11t'sllt�I still,1 111t-lf 1. { • . @wdj3DM -J WR co OFFICIAL USE M Postage $ � is 41 ru Certified Fee 07 O p p ReReturnReceipt Fee V�H �g -+ p (Endorsement Requi "P red) Restricted Delivery Fee p (Endorsement Required) Lr) Lgpg ra Total Postage&Fees s ru `.D Se To 'A O Street,Apt.No.; ! "`� r- or po Box No. \Z& f�� PO City State,ZIP+4 MA �Z�� Certified Mail Provides: o A mailing receipt 13 A unique identifier for yogr mailpiece 13 A record of delivery kept by the Postal Service for two years Important Reminders: • Certified Mail may ONLY be combined with First-Class Maile or Priority Maile. p Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. Is For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPSe postmark on your Certified Mail receipt is required. a For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery a If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. if a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT.Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530.02-000-9047 f Town of Barnstable (' x Barnstable a 'THE r Regulatory Services Thomas F. Geiler, Director A"mericaCiw �' Public Health Division I ► + BARN STABLE, MASS $ Thomas McKean, Director �Ar i639 a`0 200 Main Street �oc.I� Fp MAC Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 CERTIFIED MAIL 7C06 2150 0002 1038 7404 November 4, 2009 Michael and Alyson Rolfe 176 Bog Rd. Marstons Mills, MA 02649 RE: Assessors (045/017/002) As of October 1, 2006 a new rental registration ordinance was put into affect requiring all property owners of rental units to register their rental units with the Town of Barnstable Health Division. According to our records, you have a rental property at 176 Bog Rd., Marstons Mills. Enclosed is an application. Please use a separate application for each rental unit you own. Should you need more applications, they are available online at www.town.barnstable.ma.us. Go to the Health Division page by looking in the Department Menu. There is a link to the Rental Registration information on the Health Division page. You may print out as many as you need, and return them to the Health Division with the appropriate 2009 fees included. Please contact me or the Division Assistant to schedule inspection of the property as soon as possible. If there are tenants presently occupying the property please provide the contact information being sure to include a daytime phone number for all tenants. For your use an occupant's permission form has been included to allow for inspections to be. performed in the tenant's absence. Failure to comply with this ordinance will result in the issuance of a non-criminal ticket citation in the amount of$100. Each day of non-compliance is considered a separate offense. Should you have any.questions, please feel free to call 508-862-4644. Thank you in advance for your cooperation. Jaime A. Cabot, R.S. Health Inspector Health Division Direct#508-862-4651 Ac..c.i Barnstable Assessing Search Results Page 1 of 2 '11 New Interactive Maas» Owner: 2009 Assessed Values: ROLFE,MICHAEL C& ROWE,ALYSON E. 176 BOG ROAD Appraised Value Assessed Value Map/Pareet/Parcel Extension Building Value: $477,600 $477,600 045 /017/002 Extra Features: $24,000 $24,000 Outbuildings: $21,700 $21,700 Mailing Address Land Value: $ 165,000 $ 165,000 ROLFE,MICHAEL C& ROWE,ALYSON E. Totals $688,300 $688,300 176 BOG RD Residential Exemption Received=$100,964 MARSTONS MILLS,MA.02648 Arl • o V r 2-- __ 2009 REAL ESTATE Tax Information: Tax Rates:(per S1,000 Of valuation) Community Preservation Act Tax $ 121.58 Fire District Rates Town Residential Barnstable FD-All Classes $2.37 $6.90 C.O.M.M.-All Classes $1.08 Town Commercial C.O.M.M.FD Tax(Residential) $743.36 Cotuit FD-All Classes $1.43 $6.12 Hyannis-Residential $1.78 Town Tax(Residential) $4,052.62 Hyannis-Commercial $2.77 W Barnstable-All Classes $2.11 Community Preservation Act 3%of Town Tax Total: $4,917.56 Construction Details Building Property Sketch& ASBUILT Cards Building value $477,600 Interior Floors Hardwood Style Colonial Interior Walls Plastered -W Model Residential Heat Fuel Gas 4 Grade Custom Heat Type Hot Air `FUS' BAS R6 5.• 1u BMT 4.3 Stories 2 Stories AC Type Central =LATH 16 MS o i@. 18., I$„ Igy Exterior Walls Wood Shingle Bedrooms 3 Bedrooms TFQ"'! Roof Structure Gable/Hip Bathrooms 3 Full+ 1H Roof Cover Asph/F GIs/Cmp living area 3352 AsBuilt Card N/A Replacement Cost $482470 Year Built 2003 http://www.town.bamstable.ma.us/assessing/2009/displayparcelO9map.asp?mappar=0450... 10/26/2009 ppAA,�, TOWN OF BARNSTABLE EC. LOCATION �l�b' R.0 SEWAGE # 3 VILLAGE M' 5` D �' MKIS ASSESSOR'S MAP & LOT ~Z INSTALLER'S NAME&PHONE NO. CAL., — SEPTIC TANK CAPACITY l SDn (4 t O LEACHING FACILITY_(type)' 14(fo x 1(0 �-• (size) PE4F P)Pg- NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: �I� COMPLIANCE DATE: f Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by I j a C � q4.V o 1 07.... -e a � a9a� F �q G T3 � 77 c ENVIROTECHLABORATORIES,I.1VC. MA CERT.NO.:M-MA 063 449 Rte. 130 Sandisich, MA 02563 RE'CE-1 -ED 508(888-6460) 1-800-339-64?,0 FAX(508)888-6446 A V G 0 8 2003 TOWN OF BARNST ABLS HEALTH DEPT. CLIENT. Mike Rolf LOCATION: , 176 Bog Rd \_, ADDRESS: PO Box 864 Marstons Mills MA'\ Hyannis MA 02601 COLLECTED BY: D Pennini SAMPLE DATE: 7/23/2003 SAMPLE TIME: 3:00 WATER SAMPLE TYPE: New Well DATE RECEIVED: 7/24/2003 LAB I.D. #; 0307571 WELL SPECS.: 28' RESULTS OF ANALYSIS: Parameters Units Recommended Results Method Date Analyzed Limits Coliform bacteria / 100ml 0 0 9222 B 7/24/2003 PH pH units 6.5-8.5 6.52 4500 H+ 7/24/2003 Conductance umhos/cm 500 88 120.1 . 7/24/2003 Nitrate-N mg/L 10.0 1.19 300.0 7/24/2003 Nitrite-N mg/L 1.00 < 0.004 300.0 7/24/2003 Sodium mg/L 20.0 9.0 200.7 7/24/2003 Iron mg/L 0.3 < 0.1. 200.7 7/24/2003 Manganese mg/L 0.05 < 0.008 200.7 7/24/2003 Volatile Organics Chloroform ug/L 80 0.8 EPA 524.2 08/01/2003 WATER MEETS EPA STANDARDS AND IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED. <=less than Date >=greater than o I J. Saari #Y TNTC=too numerous to count Laboratory Dire or R.I. Analytical AUG o 8 2003 Specialists in Environmental Services TOWN OF BARNSTABLE HEALTH DEPT. CERTIFICATE OF ANALYSIS Envirotech Laboratories, Inc. Date Received: 07/25/2003 Attn: Mr. Ron Saari Date Reported: 08/01/2003 8 Jan Sebastian Drive P.O.#: Sandwich, MA 02563 Work Order#: 0307-10346 DESCRIPTION: ROLF (ONE DRINKING WATER SAMPLE) Subject sample(s)has/have been analyzed by our Warwick,R.I. laboratory with the attached results. Reference: All parameters were analyzed by U.S. EPA approved methodologies and all NELAC requirements were met. The specific methodologies are listed in the methods column of the Certificate Of Analysis. Data qualifiers(if present)are explained in full at the end of a given sample's analytical results. Certification#: RI-033,.MA-RI015, CT-PH-0508,ME-RIO15 NH-253700 A &B, USDA S-41844,NY-11726 If you have any questions regarding this work,or if we may be of further assistance,please contact us. Approved by Paul P Vustody Data e enc: Ch 41 Illinois Avenue,Warwick, RI 02888 131 Coolidge Street, Bldg 2, Hudson, MA 01749 Tel: (401) 737-8500 Fax:(401) 738-1970 Tel:(978) 568-0041 Fax: (978) 568-0078 s C 2 of 3 R.I.Analytical Laboratories,Inc. CERTIFICATE OF ANALYSIS Envirotech Laboratories, Inc. Date 07/25/2003 Approved Work Order#: 0307-10346 .I. alytical Sample# 001 SAMPLE DESCRIPTION: 0307571 176 BOG ROAD 7 SAMPLE TYPE: GRAB SAMPLE DATE/TIME: 07/23/2003 @15:00 SAMPLE DET. DATE PARAMETER RESULTS LIMIT UNITS METHOD ANALYZED ANALYST Vclatile Organic Compounds Bromodichloromethane <0.5 0.5 ug/l EPA 524.2 08/01/2003 AMT Bromoform <0.5 0.5 ug/l EPA 524.2 08/01/2003 AMT Dibromochloromethane <0.5 0.5 ug/l EPA 524.2 08/01/2003 AMT Chloroform 0.8 0.5 ug/I. EPA 524.2 08/01/2003 AMT 1,2-Dibromoethane(EDB) <0.5 0.5 ug/l EPA 524.2 08/01/2003 AMT Benzene <0.5 0.5 ug/l EPA 524.2 08/01/2003 AMT Carbon Tetrachloride <0.5 0.5 ug/l EPA 524.2 08/01/2003 AMT 1,2:-Dichloroethane <0.5 0.5 ug/l EPA 524.2 08/01/2003 AMT Triehloroethene <0.5 0.5 ug/l EPA 524.2 08/01/2003 AMT 1,4-Dichlorobenzene <0.5 0.5 ug/l EPA 524.2 08/01/2003 AMT 1,1-Dichloroethane <0.5 0.5 ug/l EPA 524.2 08/01/2003 AMT 1,1.1-Trichloroethane <0.5 0.5 ug/l EPA 524.2 08/01/2003 AMT Vinyl Chloride <0.5 0.5 ug/l EPA 524.2 08/01/2003 AMT Bremobenzene <0.5 0.5 ug/l EPA 524.2 08/01/2003 AMT Brcmomethane <0.5 0.5 ug/l EPA 524.2 08/01/2003 AMT Chforobenzene <0.5 0.5 ug/l EPA 524.2 08/01/2003 AMT Chloroethane <0.5 0.5 ug/l EPA 524.2 08/01/2003 AMT Chlaromethane <0.5 0.5 ug/1 EPA 524.2 08/01/2003 AMT 2-Chlorotoluene <0.5 0.5 ug/l EPA 524.2 08/01/2003 AMT 4-Chlorotoluene <0.5 0.5 ug/l EPA 524.2 08/01/2003 AMT Dibromomethane <0.5 0.5 ug/l EPA 524.2 08/01/2003 AMT 1,3-Dichlorobenzene <0.5 0.5 ug/l EPA 524.2 08/01/2003 AMT 1,2-Dichlorobeazene <0.5 0.5 ug/l EPA 524.2 08/01/2003 AMT tran3-1,2-Dichloroethene <0.5 0.5 ug/l EPA 524.2 08/01/2003 AMT cis-1,2-Dichloroethene <0.5 0.5 ug/l EPA 524.2 08/01/2003 AMT Methylene Chloride <0.5 0.5 ug/l EPA 524.2 08/01/2003 AMT 1,1-Dichloroethene <0.5 0.5 ug/l EPA 524.2 08/01/2003 AMT 1,1-Diehl oropropene <0.5 0.5 ug/l EPA 524.2 08/01/2003 AMT 1,2-Dichloropropane <0.5 0.5 ug/l EPA 524.2 08/01/2003 AMT 1,3-Dichloropropane <0.5 0.5 ug/l EPA 524.2 08/01/2003 AMT cis-1,3-Dichloropropene <0.5 0.5 ug/l EPA 524.2 08/01/2003 AMT 2,2-Dichloropropane <0.5 0.5 ug/l EPA 524.2 08/01/2003 AMT Ethylbenzene <0.5 0.5 ug/l EPA 524.2 08/01/2003 AMT Styrene <0.5 0.5 ug/l EPA 524.2 08/01/2003 AMT 1,1,2-Trichloroethane <0.5 0.5 ug/l EPA 524.2 08/01/2003 AMT 1,1,1,2-Tetrachloroethane <0.5 0.5 ug/l EPA 524.2 08/01/2003 AMT 1,1,2,2-Tetrachloroethane <0.5 0.5 ug/l EPA 524.2 08/01/2003 AMT Tetrachloroethene <0.5 0.5 ug/l EPA 524.2 08/01/2063 AMT 1,2,3-Trichloropropane <0.5 0.5 ug/l EPA 524.2 08/01/2003 AMT Toluene <0.5 0.5 ug/l EPA 524.2 08/01/2003 AMT f 3 of 3 R.I.Analytical Laboratories,Inc. CERTIFICATE OF ANALYSIS Envirotech Laboratories, Inc. Date 07/25/2003 Approv by: Work Order#: 0307-10346 .I nalytical Sample# 001 SAMPLE DESCRIPTION: 0307571 176 BOG ROAD SAMPLE TYPE: GRAB SAMPLE DATE/TI 07/23/2003 @15:00 SAMPLE DET. DATE PARAMETER RESULTS LIMIT UNITS METHOD ANALYZED ANALYST Xylenes <0.5 0.5 ug/1 EPA 52.4.2 08/01/2003 AMT _',2-Dibromo-3-Chloropropane <0.5 0.5 ug/1 EPA 524.2 08/01/2003 AMT Bromochloromethane <0.5 0.5 ug/1 EPA 524.2 08/01/2003 AMT n-Butylbenzene <0.5 0.5 ug/1 EPA 524.2 08/01/2003 AMT Dichlorodifluoromethane <0.5 0.5 ug/1 EPA 524.2 08/01/2003 AMT Trichlorofluoromethane <0.5 0.5 ug/l EPA 524.2 08/01/2003 AMT Hexachlorobutadiene <0.5 0.5 ug/l EPA 524.2 08/01/2003 AMT Isopropylbenzene <0.5 0.5 ug/1 EPA 524.2 08/01/2003 AMT p-Isopropyltoluene <0.5 0.5 ug/1 EPA 524.2 08/01/2003 AMT Naphthalene <0.5 0.5 ug/1 EPA 524.2 08/01/2003 AMT n-Propylbenzene <0.5 0.5 ug/1 EPA 524.2 08/01/2003 AMT sec-Butylbenzene <0.5 0.5 ug/1 EPA 524.2 08/01/2003 AMT tert-Butylbenzene <0.5 0.5 ug/1 EPA 524.2 08/01/2003 AMT 1 2,3-Trichlorobenzene <0.5 0.5 ug/1 EPA 524.2 08/01/2003 AMT 1.2,4-Trichlorobenzene <0.5 0.5 ug/1 EPA 524.2 08/01/2003 AMT 12,4-Trimethylbenzene <0.5 0.5 ug/1 EPA 524.2 08/01/2003 AMT 1,3,5-Trimethylbenzene <0.5 0.5 ug/l EPA 524.2 08/01/2003 AMT Methyl Tertiary Butyl Ether(MTBE) <► 1 ug/1 EPA 524.2 08/01/2003 AMT n-Hexane <10 10 ug/1 EPA 524.2 08/01/2003 AMT SURROGATES RANGE EPA 524.2 08/01/2003 AMT 4-Bromofluorobenzene 105 80-120% EPA 524.2 08/01/2003 AMT 1,2-Dichlorobenzene-d4 99 80-120% EPA 524.2 08/01/2003 AMT '�No. � � � �' Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: t Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2pplication for Migw6al *pgtem Congtruction Permit Application for a Permit to Construct( 'Repair( )Upgrade( )Abandon( ) Complete System ❑Individual Components Location Address or Lot No. 1 2G Owner's Name,Address and Tel.No. Assessor's Map/Pazcel � ►Yl t �S �� ca`�l C �l��c �^ O f7-- b d d 5zs wear 2 cd Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Pit vv,, ..,� Ak �� r Type of Building: —�.S�J Dwelling No.of Bedrooms Lot Size 'sq.ft. Garbage Grinder( ) Other Type of Building- No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow //0 gallons per day. Calculated daily flow 3 3'0 gallons. Plan Date &*4i]a co Number of sheets O"k- Revision Date C +.. Zov3 Title 1� ply, Size of Septic Tank D gc(_ Type of S.A.S. Description of Soils �- Nature of Repairs or Alterations(Answer when applicable) . Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance It b i ued by this Board of Health. Si Date Application Approved b Date ��la Application Disapproved for the following reasons Permit No. Date Issued O --------------------------------------- No,C/�'3%^3 L Fee Al "i^ V V e THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: »r Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE MASSACHUSETTS 2pplication for MU;p0al *pgtem Construction Permit Application for a Permit to Construct('Repair( )Upgrade( )Abandon( ) Complete System El Individual Components Location Address or Lot No. 1'T 6 (� > Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ?x of fly Type of Building: `/ SDI Dwelling No.of Bedrooms Lot Size 'sq.ft. Garbage Grinder( ) Other Type of Building ��of• No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow //0 gallons per day. Calculated daily flow 330 gallons. Plan Date P no 3 Number of sheets Revision Date . Title 5'�f Size of Septic Tank IS ac l Type of S.A.S. ' Description of Soil -will Nature,of Repairs or Alterations.(Answer;{when applicable) t• f! Date last in pected: 061 1 'iv r Agreement: The'undersigned agrees,to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the-provisions of Title 5 of the Environmental Code and not to place the•system in operation until a Certifi- cate of Compliance has eeNi§ssued by this Board of Health. Sigel'A- .-t�r Je D s Date Application Approved bb. \..�1 r— --� r Date P:iC 10 Application Disapproved for the following reasons ` r Permit No. f Date Issued U - ----------------------------------- THE COMMONWEALTH OF MASSACHUSETTS - i BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( Repaired( )Upgraded Abandoned(. )by _ at 1-7(w ` ►0 r r r �.1 n ft)%N\S has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 0 ot,)l -37 ddated /r, r)Z Installer?-�_fin.. ( ;��;, ;�� {n r Designer t The issuance of s pe * t shall not be construed as.a guarantee that the sy tem llfunction as ysi ed. Date <�_ Lf Inspector No. r�—.�� /00 ��- �o -------------------------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS li5poe;af *pgtem Construction Permit Permission is hereby granted to Construct"epair( )Upgrade( )Abandon( ) System located at R f dj Ga h 4 t l s he and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions.' Provided:Construction must be completed within three years of the da�byy of this I! Date• ��O 3 Approved N } D03,0 _ __________________ o,__W____________ Fee BOARD OF HEALTH TOWN OF BARNSTABLE 6 00(pprication for lVell Cootruction Permit Applicatio/� is he y made for a permit to nstruct ('�, Alter ( ), or Repair ( )an individual Well at: JJ o 6 � O4a 1s YcO H,s /M /�So - -- - - - - ---------------- — -- -- Location — Address Assessors Map and Parcel / ` a/3/(& -,S AA l Owner � q Address wc_I l�iL'- -- --- —�°-�°x-- /tea Installer — riller Address — ---_ — Type of Building Dwelling ----- --- -- -- Other - Type of Building----------------- No. of Persons---------------------------------- Type of Well -- — Capacity---— - - --—— ---------— Purpose of Well----0=`ta°J �c —(,—'4 °i------- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certifica a .of ompliance has been issued by the Board of Health. GIJGfiS Signed �—- - -date Application Approved By - / ---- ` date Application Disapproved for the following reason .--------------------------- - ---------- --------—-- — — —--- ---- —date — Permit No. — -- -- Issued— --------- —— --�� date BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate Of COMPhance THIS IS TO CERTIFY, That the ndividual Well Constructed ('I, Altered ( ), or Repaired ( ) ��w,��I" -----_- --------------- ------------------------------------------------------------- by------ Installer at- ---� �o(o ✓tic( has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. ------- -Dated---- ----- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE------- -- — Inspector-- - —--— --- -- - --- li No.-------------- ! Fee BOARD OF OF HEALTH ` TOWN OF BARNSTABLE ZppCuationArWell Con.Otruct ion 3pernut f Applicatioj is he4ey made fora permit to onstruct Alter ( ), or Repair ( )an individual Well at: f Add ------- — Assessors Ma and Parcel ress Location — j� P AA I — G— Owner / g / �SCli+ ✓�,P ��wc // lJ/i! �" -- — b, �k _/ �D .. � j ` Installer — Driller i Address Type of Building Dwelling --- - -- - ---------- Other - Type of Building---------------- - No. of Persons---------------------------- l' TYPe of Well 7-�- Capacity- --------------- -- Purpose of Well---o`U --- Agreement: I The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to .4place the well in operation until a Certificate .of ompliance has been issued by the Board of Health. C✓fG cu� // / __ Signed date Application Approved B —(, / ---- PP PP y v tf A date Application Disapproved for the following reason : --------- --- ---- - ---— ----_-- � �— �! _ date -- s Permit No. --�--- -- Issued-- �---- 'V -;� i date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of CoTnPhante THIS IS TO CERTIFY, That/the ndividual ell Constructed ('�, Altered'( ), or Repaired ( ) / --Intaller--------------------------- ------- ---- i s at lo� has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. ------------------Dated----- -------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. (' DATE-------- Inspector—___- - - --------- - BOARD OF HEALTH TOWN OF BARNSTABLE ell CongtructionVemit >>�- " -- -` -V t Fee- No. ! - --- No. i Permission is hereby granted D A to Construct ( �), Alter ( a ), or Re air ( ) a Individual Well at: D b as shoy'mq�o/n t(he a p�ation f r �el1l construction Permit No.---v V—�� J /�� . /ll ,_ Dated �f- ^i '�-L- --------------------------- Board,of Health DATE -- Towfi of Barnstable PH P10.499 Department of Health,Safety,and Environmental Services Public Health Division Date off d3 367 Main Street,Hyannis MA 02601 4I eearter�er,s, Date Scheduled 2 03 Time MA11`1 Fee Pd. Soil Suitability Assessment for Sewage Disposal Performed By: Witnessed By: C3a W LOCATION:&;GENERAL INFORMATION: Location Address Owner's Name. l, b �vI�e Ccxi��vu� Address Assessor's Map/Parcel: 4-5 I 1-7 —a Engineer's Name �_kpe NEW CONSTRUCTION t-� REPAIR Telephone# Land Use w 61)k� v- L�' Slopes(%) Surface Stones t t} `4. Distances from: Open Water Body ?v ft Possible Wet Area 17S' ft Drinking Water Well A00 —ft Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) i� �g Gc we/L - �o 6Z�v4� Parent material(geologic) C'BA R u'-V Depth to Bedrock ter' Depth to Groundwater: Standing Water in Hole: A26 dU L` Weeping from Pit Face NG�� Estimated Seasonal High Groundwater "I pwpJ, r JC >::<:::>:: <::....<:<::>}:::»<;1. ...........N.... E ,... ....N...:: ...I.O. .:N...,..'O..:..t.:. E A W LE - Method Used .... eke . Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well!/_ ..•_ Rredine Date: Inde el evel. _.___ A�Ij.factor Adj.Groundwater Level PERCC�EATI(1N TEST lme� Observation Hole# Time at 9" Depth of Perc Time at 6" Start Pre-soak Time® Time(9"-6") End Pre-soak f�-I S N 9� /T a y i" `� �v1•e ��t Ll r+�-� Rate Min./Inch �. Site Suitability Assessment: Site Passed_ Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back-� Copy: Applicant t� DEEP.OBSERVATION:HOLE LOG Hole# 1 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. % tdvqV-N E�xs�� 72G ..� n s w / N� DEEP OBSERVATIONHOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.0Gravell d—�` S L� 1G R f/ ��ay IJ row C ^-eASNw1 fi ell,*AG- >: bEEP OB$9 VA.T.1O ['TDL LOC Hole# Depth from Soii Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. ° Gravel) DEEP OBSERVATION HOLE LOG Hvle# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.° Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes ✓ Within 500 year boundary No Yes Within 100 year flood boundary No_ Yes Depth of naturally Occurring Pervinuc Mofnriol Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? S If not,what is the depth of naturally occurring pervious material? Certification. I certify that on �v 4 (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expe ' e and experien described in 310 CMR 15.017. Signature Date !C &3 llL NOTE.• NO SEPTIC WITHIN 150 FEET OF WELL , BOG AI,, ,� _� ¢ /RACE LANE CRANBERRY B OF 0 4% ` .II. ED%E o 1 �cz �� `� ° LOCUS BAG-- IL Vq VER \ cro \ \\ / LOCUS MAP PLAN REF- 453/50 o` o_ A. M. 4517-2 \ \ ZONING : RF" � A / ` GROUND WATER PROTECTION DISTRICT b AREA=43,561f SF \ PROPOSED 1 co all, "GP"' pG WELL '`, FLOOD ZONE. "C" G E OF E 1 TOP OF BOG ---- — ---------- \� E O � _ I COMMUNITY PANEL # -�-- B�l� \ 1 � EL = 44.2 250001-0015-C \ � PROPOSED GK �� \ _ _G_RA V_EL DRIVE HA 1 I 1 \ S7rJNE 1�150 � V1 ► ► AUGUST 19, 1985 I I 0 I IL GARAGE SLAB AL=48• 56 //PROPOSED 0 16 I j 64. w 1 1 � DWELLING T.O.F: EL=SB' \ � I I SITE & ,SE'PTIC PLAN \\o� \` ,--_ `\ � �o s� I i i LOCATED AT #176 BOG ROAD MARSTONS MILLS, MA. E 7` M&o' , PREPARED FOR• o \\� p Eo DRIB ,I !�' _ , H - \ 2 . ' � , MIKE' ROLFE - , 6 ti 0 I MAY 29, 2003 dL, REV. JUNE 2, 2003 (SEPTIC TANK LOCATION) ITPI ae \ \ \ O 1 .0 SCALE 1':• = 30 FEET 52 5 p I \ � Pyy A \ �� 5407750E 208. 96 fop �c o `� N\ A YANKEE SURVEY CONSULTANTS g 5g 5 \o of �� \ �-\N OFF#,qs'�. UNIT 1, 40B INDUSTRY ROAD A.M. 45/17-3 �, BRUCE tiG� ��oS�.-`; PAUL A.""':y= P. O. BOX 265 G. MERITHEW ARSTONS MILLS, MASS. 02648 MU. 749 y =o 3209e TEL: 428—0055 FAX 420—5553 C� -BSDRoov ~•' '* 0_ DWELUNC 8.0 " \. S, SUR ;;�C ,B.o' 2' ��r AR\ " SHEET 1 OF 2 J# 53399 GM TOP OF F10UNDATION 20' MIN. , a 10 MIN. CONCRETE CO VERS 4" SCHEDULE 40 P. VC 2"LAYER OF MIN. PITCH 1/8 PER FT. 1/8"-1/2" 56.0' CONCRETE COVER WASHED S70NE I \ • • / / • • / / / EL=54.0 MAX i ,B" MAX / / / .1 i , , i / , C 4' CAST IRON PIPE 6 es (OR EQff AP) PER FT. CLEAN SAND 9 MIN. PIPE PI7L^H 1/16" PER FT.= a 005 MIN FLOW LINE EL=51.0' INVERT 1 N EL.=54_0__ INVERT LEVEL o 0 0 ° ° ° ° o o °o 14" 20 0 0 0 0 00 0 00 0 „ o0 00 coo ° 0 0 D CAP GAS _ 53.25' �6 SUM o00 0000000 ° 6 00000000 00 0 INVERT BAFFLE INVERT INVERT o o aq o $ 0 $ o 0 0 � o e ° 0 0° L.=50.0' WALKOUT EL=48' EL.= 53.5' EL.= 51.0 _ EL.= 50. 75 (70 BE PLACED ON F7RM BASE) DISTRIBUTION INVERT MECHANICALLY COMPACTED OR 6" OF STONE BOX "DB—9" EL•= 50.5' 40x 16x 6 __100---GALLONS Yip HE WATER TESTED - „ IF MORE THAN ONE OUTLET FIELD FORMATION � o SEPTIC TANK 20 PLACE ON 6" STONE 3/4" T10 1-1/2" SOIL ABSORPTION 0 de.Lli tf DOUBLE WASHED SMA E SYSTEM (SAS) TOP OF BOG EL = 44.2' PROFILE OF �° �` v�.. = 43' SEWAGE DISPOSAL SYSTEM a��c � a.,l NO OBSERVED WATER . TABLE (5/28/03) ELEV. ____ � OBSERVATION HOLE I ELEV.= 54'__ NOT TO SCALE PERCOLATION RATE G2 MIN./ INCH AT _3FZ" INCHES OBSERVATION HOLE 2 ELEV.=_54'_ DEPTH HORIZ TEXTURE COLOR MOTT OTHER DEPTH HORIZ TEXTURE COLOR MOTT. OTHER 0-8" A SANDY LOAM IOYR 5-1 0_8» A SANDY LOAM 10YR 5-1 8"-24" B LOAMY SAND IOYR 6-6 8"-24" B LOAMY SAND IOYR 6— GENERAL NOTES 24"-120 CI MEDIUM SAND IOYR 6-4 4"-132' Cl MEDIUM SAND IOYR 6-4 PERC & GRA VEL 1) ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO R E.P. TITLE 5 AND THE TOWN OF _BARLNS'TABLE___— RULES AND NO WATER ENCOUNTERED NO WATER ENCOUNTERED REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. 2) ONE COVER ON SEPTIC TANK SHALL BE BROUGHT TO SOIL TEST WITHIN 6" OF FINISHED GRADE, OTHERS WITHIN 10" DATE OF SOIL TEST 5128/03 SOIL TEST DONE BY BRUCE G. MURPHY, R.S. 3) ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF WITNESSED BY: SA WHITE WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 5 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE P#IO, 4 74 DESIGN CALCULA TIONS.' USED UNDER OR WITHIN 5 FT. OF DRIVES OR PARKING AREAS. NUMBER OF BEDROOMS . 3 4) ANY MASONARY UNITS USED TO BRING CO VERS TO GRADE SHALL GARBAGE DISPOSAL . . . . . . . . . NO BE MORTERED IN PLACE. 5) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH LEACH FIELD 40' X 16' X 6" TOTAL ESTIMATED FLOW DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO INSTALL LEACH-FIELD IN MEDIUM ( 110—_GAL/BR./DA Y x 3__— BR.) 330 GAL/DA Y OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. HORIZON REQUIRED SEPTIC TANK CAPACITY 1500 GAL 6) UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR SOIL CLASSIFICATION . . . . . . . . 1 0 IS TO CALL "DIG— SAFE" AT 1—800—322—4844 AT LEAST 72 HOURS DESIGN PERCOLATION RATE . . . . . < 2 MIN./IN. PRIOR TO COMMENCING WORK ON SITE. EFFLUENT LOADING RATE . . . . . . . 74 GAL/DA Y/S.F. 7) CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS j LEACHING CAPACITY (40 X 16 X . 74 473 GAL/DA Y SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. RESERVE LEACHING CAPACITY . 378 GAL/DA Y 8) PARCEL IS IN FLOOD ZONE___ . 9) LOT IS SHOWN ON ASSESSORS MAP _45_ AS PARCEL —17=2—. (32x16x. 74) a' SHEET 2 OF 2 JOB NUMBER__ 53399 ______ 1